Vol 2-2 Commentary

Commentary: Chemoradiotherapy for locally advanced squamous cell carcinoma of the oropharynx: Does completion of systemic therapy affect outcomes?

Richard Sleightholm BS1 and Michael J Baine MD PhD2*

1Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA

2*Department of Radiation Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA

Concurrent chemoradiotherapy plays a vital role in the treatment of locally advanced squamous cell carcinoma of the oropharynx (LA-OPC). Importantly, only 50-85% of patients undergoing this treatment are able to complete their prescribed chemotherapy courses due to treatment-associated morbidity. The significance of chemotherapy completion, or lack thereof, remains unknown in this setting. To further investigate if chemotherapy non-completion affects patient outcomes, a single institutional retrospective study was undertaken analyzing 73 patients undergoing definitive radiation for LA-OPC and revealed a near-significant trend toward improved overall survival on multivariable analysis (p=0.053) in those completing chemotherapy. We are presently providing a commentary on this manuscript in an attempt to provide context and further interpretation of the presented results as well as suggest areas in need of additional investigation.

DOI: 10.29245/2578-2967/2018/2.1125 View / Download Pdf View Full Text
Vol 2-2 Review

Positive Psychological Change in Head and Neck Cancer populations

Sam Harding

DHealthPsych, Pines and Steps Southmead Hospital North Bristol Hospital Trust, Bristol, United Kingdom

Head and neck cancer (HNC) carry a high level of morbidity and mortality, but the impact of HNC on survivors differs widely among individuals, and a significant number of them suffer from negative psychological effects of the disease. However, some people report a significant positive effect of experiencing HNC and its treatment.

This review looks at demographic, clinical and psychological factors associated with positive psychological change (PPC) in HNC populations.

Eight quantitative manuscripts were identified as reporting on PPC in HNC. These studies were split between recruiting participants via cancer clinics and postal surveys, and the majority use a cross-sectional study design.

Demographic factors across the papers showed similar patterns of relationships across PPC; that higher education/qualification and cohabitation/marriage are associated with increased PPC. Limited research reported longitudinal patterns of change and showed that for people with lower stage tumours and those who only had a surgical intervention greater PPC developed over time. Multivariable modeling adjusting for psychosocial variables found that PPC had a quadratic relationship with time since diagnosis, increasing initially and leveling off after 18 months.

Further research would aid the identification of bio-psychosocial factors that influence the development of PPC and inform the development of rehabilitation interventions while enabling consideration of the natural development of the phenomenon.

DOI: 10.29245/2578-2967/2018/2.1126 View / Download Pdf View Full Text
Vol 2-2 Mini Review

Advances in Clinical Application of ctDNA Detection in NSCLC

1Kang Qin, 2Helei Hou and 3*Xiaochun Zhang

1,2,3*Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China

With high morbidity and mortality, lung cancer has become the leading cause of cancer-related death worldwide, of which 85% are non-small-cell lung cancer (NSCLC). Most patients present with advanced disease at diagnosis and 5-year survival rate is no more than 30% due to lack of appropriate screening and early detection. In spite of tissue samples, ctDNA (circulating tumor DNA) is also widely used for molecular profiling to guide the treatment of NSCLC for lots of advantages. This review mainly focuses on the clinical and investigational applications of ctDNA detection in facilitating the personalized therapy of NSCLC.

Initially reported by Mandel et al. in 1948M1, cfDNA (cell-free DNA) refers to the acellular, free DNA fragments in circulation (plasma or serum) derived from somatic cells through mechanisms like necrosis, apoptosis and exosome secretion. ctDNA is cfDNA generated by tumor cells, which carries cancer-associated genetic alterations2,3. In 1977, Leon et al. first reported that the level of plasma ctDNA of patients with cancer was significantly higher than that of normal persons4, which was also confirmed in NSCLC5,6. In NSCLC patients, techniques for targetable genetic ctDNA detection have improved from traditional ARMS, HPLC, BEAMing, FISH to new generations of NGS (next generation sequencing), ddPCR and CAPP-Seq etc. Compared with traditional detection methods, NGS shows extraordinary advantages like massively parallel sequencing, lower-inputs, cost-effectivity, ultra-sensitivity and hyper accuracy7,8. The main applications of ctDNA detection in the personalized treatment of NSCLC patients will be discussed in this review.

DOI: 10.29245/2578-2967/2018/2.1121 View / Download Pdf View Full Text
Vol 2-2 Mini Review

The Challenges of Screening Mammography in Racial/Ethnic Minority Populations in the United States: A mini-review and observations from a predominantly Hispanic community.

Julia E. McGuinness1* and Katherine D. Crew1,2,3

1Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032

2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032

3Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032

Screening mammography is recommended by U.S. medical organizations for breast cancer screening in average risk women because of its demonstrated reductions in breast cancer mortality. However, significant disparities in breast cancer screening utilization and mortality remain among racial/ethnic minorities. Efforts have appropriately been directed at increasing engagement with screening services in these populations, however, there is a dearth of data regarding false-positive rates and overdiagnosis in minority patients engaged in breast cancer screening. We recently examined screening practices among a predominantly Hispanic population presenting to an academic medical center in New York, NY, and found that approximately 53% of women experienced at least one false-positive mammography result over a median of 8.9 years of screening. We also observed that Hispanic women were more likely to screen annually than white women despite recommendations to screen less frequently. In this review, we briefly review the benefits and harms of screening mammography in average-risk women, namely, false-positive results and breast cancer overdiagnosis, followed by a discussion of the disparities in breast cancer screening and mortality among racial/ethnic minority populations. We then present our own recent observations and propose that future interventions among Hispanic and other minority populations could include patient- and provider-centered educational programs that focus on providing a balanced discussion of benefits and harms of screening mammography.

DOI: 10.29245/2578-2967/2018/2.1128 View / Download Pdf View Full Text
Vol 2-2 Mini Review

A Review of Osteosarcoma Therapeutics

Michael W. Beaury1, Megan L. Kelly-Beaury2, Gilbert Sharp3, Jessica A. Cottrell4*

Seton Hall University, South Orange, NJ, USA

Osteosarcoma is a rare but deadly cancer, predominantly affecting both adolescent and young adult populations. Osteosarcoma occurs when an aggressive malignant neoplasm arises from transformed cells of mesenchymal origin, which eventually produce a malignancy in the osteoid. Diagnosis of osteosarcoma typically results from symptoms of pain or swelling in the bone, which can be confirmed through laboratory testing of alkaline phosphatase and lactate dehydrogenase levels as well the detection of microscopic and macroscopic lesions. Pathogenesis of osteosarcoma is caused by a diverse set of factors including physical agents, radiation, chromosomal aberrations and viral infection which dysregulate cellular functions. Current research focuses on understanding how microRNAs play a role in osteosarcoma and other aggressive cancers. In this review, we discuss current treatments options including chemoresistant strategies and immunotherapies that show promise at combating osteosarcoma and other cancers.

DOI: 10.29245/2578-2967/2018/2.1127 View / Download Pdf View Full Text